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Today, a 45 year old baseball pitcher described a pain in his shoulder that only hurt when he crossed his arms and pressed his fist into the back of his arm, pushing his arm forward causing local pain in the front of the shoulder more or less. He also described getting grossly fatigued while pitching, losing both velocity and staying power. The pain came on originally after he pitched through an illness.
Physical exam was insignificant. Rotator cuff screens were negative as was the AC joint screen. Palpation unable to reproduce symptoms. Muscle test negative. Neuro negative. Joint play negative. The only positive symptom occurred with him reproducing the anterior glide of the humeral head on the glenoid using his other hand behind the involved right arm.
My conclusion is that he tore his Glenoid Labrum. We will find out for sure after he has an MRI or surgery if the surgeon decides to go that way.
The Labrum seats around the Gelnoid Fossa to make it effectively deeper for the Humerous to seat properly. When the Labrum tears, it can tear on the top (a SLAP lesion) or on the bottom (a Bankart lesion). You can see the proximity of the biceps lesion to the superior tear in the Labrum, and for this reason, many SLAP lesions actually also involve the Biceps Tendon.
In the event that you actually have a torn Glenoid Labrum in either form, the SLAP lesion or the Bankart tear, I am afraid that the best option is surgical. The good news is that recovery is excellent. The last patient I treated who had surgery for this condition, had both the SLAP and the Bankart lesion, and he went on to a full recovery after surgery by playing college football just a few months later.
Rehab for the post surgical course is not very complex, it just takes hard work. Starting with immobilization, then self mobilization activities, to full ARROM to strengthening to dynamic strengthening and throwing ultimately.
Its a long road back for sure, but the route back to full participation is certain. “Bulletproof” shoulders are possible after surgical repair.
Jim wrote: I read a blog you posted on SLAP repair. Just a quick question for you. I have surgery scheduled. I’m a 42 y.o. h.s.coach/rec baseball player. My doc is planning on doing the same surgery that Favre had. Release of the biceps tendon and clean out spurs while re-creating the AC gap. What is your opinion on biceps tendon release? Pros and cons… Thanks.
The answer is:
The reason that the surgeons release the biceps tendon in people who are not young and active is that there is a high incidence of frozen shoulders with a strict repair. Some surgeons simply repair the labral tear, some release the biceps tendon allowing it to retract which can cause the Popeye muscle deformity, and others sew the tendon down in the biceps groove with good result. The Popeye deformity is no big deal functionally, but if it were me, I would ask for the tendon to be secured in the groove.
Comment by Neil Chasan, PT, MMT — May 29, 2010 @ 12:11 pm